Surgery for Ankylosing Spondylitis: When Is It Necessary?
Following your treatment regimen can prevent the need for these complex surgeries.
When you hear that your arthritis may one day require surgery, it’s natural to be concerned. Luckily, the majority of patients will never need surgery for ankylosing spondylitis (AS), according to Anca D. Askanase, MD, MPH, rheumatologist at Columbia University Irving Medical Center.
“Surgery is for the treatment failures. Surgery is for the time when all else failed. It's for the time when we were unable to control the disease,” says Dr. Askanase.
There are many ways to prevent complications of AS. In particular, following your treatment regiment can keep inflammation and spinal damage at bay. For people who do have complications—such as spinal fusion—surgery is available to help.
Surgeries for the Spine
There are two types of surgery for ankylosing spondylitis: cervical fusion and corrective wedge osteotomy.
Cervical fusion is used for patients who have fractures in the spine. In this procedure, your surgeon will intentionally fuse some vertebrae together. Typically, the goal of this surgery is to prevent damage to the spinal cord.
Corrective wedge osteotomy is a surgery for treating spinal fusion, particularly when it’s in a hunched-over position. In this procedure, your surgeon removes small wedges of the fused spine. Then, the surgeon fixes the spine into a better, more natural position.
“Spine surgery is not simple surgery. They are complicated, complex, long surgeries,” says Dr. Askanase. “They should be done in a center that specializes in spine surgery, where the surgeons are versed in these procedures.”
Surgeries for the Hip
In some cases, people with AS may require hip surgery. Although AS primarily affects the spine, many patients do experience inflammation in the hips that causes pain and limited mobility. When this occurs, doctors may recommend a total hip replacement.
“Hip replacements are not as big of a surgery as a spine surgery, but they are several hours' worth of surgery where both parts of the hip are now replaced with metal components that now allow for good mobility,” says Dr. Askanase.
Avoiding Surgery
Luckily, surgery for AS isn’t that common. “Most people will never have surgery. Following the medication regimen [and] lifestyle changes are very good preventive measures to the need for surgery,” says Dr. Askanase.
That’s why it’s so important to see your doctor for a diagnosis and treatment early. That way, you can start medications for AS, learn the recommended lifestyle modifications, and develop a routine that works for you and your body.
Dr. Askanase is a rheumatologist specializing in lupus, Sjogren's syndrome, and vasculitis at Columbia University Irving Medical Center. She is the founder and clinical director of Columbia's Lupus Center and the Director of Rheumatology Clinical Trials.
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(Dr. Askanase) We've learned over the
past several decades
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that unquenched inflammation leads to damage,
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and that damage manifests itself through,
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in ankylosing spondylitis, through ankylosis,
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so loss of mobility.
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(atmospheric music)
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Spinal fusion is when parts of the spine
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fuse together and become immobile.
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Traditionally, it's described as the bamboo spine.
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It's so immobile when it involves large parts
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of the spine that no movement is happening here.
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Spine fusion in a very hunched-over position
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with a very big spine deformity
requires surgical intervention.
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Spine surgeries should be done in a center
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that specializes in spine surgery.
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They're supposed to be done by a team
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of spine surgeons, possibly a neurosurgeon involved
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and provide the best relief from the deformity.
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The spine surgeries that are done are osteotomies,
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where the bone in the spine is broken
and re-aligned.
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It involves some breakage and some reconstruction
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of the spine so that now the spine is a more
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physiologic position and allows for a little more room
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for the organs in the chest.
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Ankylosing spondylitis can affect the hips.
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Hip damage results in severe immobility and pain,
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and the treatment for that is a hip replacement.
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Hip replacements are not as big of a surgery
as a spine surgery,
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but they are several hours' worth of surgery
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where both parts of the hip are replaced
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with metal components that now allow
for good mobility.
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The double whammy where both the spine
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and the hip are fused and not working well
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particularly troublesome for people with AS
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and they might find that a hip replacement
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may give them more mobility
because while there's a lot
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of bending that happens from the spine,
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some of the bending happens at the hip.
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Most people will never have surgery.
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Following the medication regimen,
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following the lifestyle changes,
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are very good preventive measures to the need for surgery.
- Ankylosing spondylitis. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2020. (Accessed on September 29, 2020)
- Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020. (Accessed on September 29, 2020)